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Calcium acetate - a Calcium-containing Phosphate Binder

In the digestive tract, calcium acetate, a calcium-containing phosphate binder, forms insoluble complexes with phosphate to create calcium phosphate. It is applied to patients with end-stage renal failure to manage hyperphosphatemia. It does not encourage the absorption of aluminium.

Calcium acetate Dose in Adults

Use for controling hyperphosphatemia in ESRD and on dialysis patients:

1334 mg orally with each meal as the starting dose.
Every two to three weeks, the dosage can be gradually increased to the recommended level of 2001–2668 mg calcium acetate with each meal. (to achieve a target serum phosphate levels of less than 6 mg/dL, if the serum calcium allows).
Additional supplements should not be advised.

Calcium acetate Dose in Childrens

Note: one gram of calcium acetate binds to 45 mg of phosphorus.

Use for controling hyperphosphatemia in patients with end-stage of renal disease:

Children and Adolescents:
- 667 - 1,000 mg orally with each meal as a starting dose.
- The dose should be titrated every 2 - 4 weeks to achieve the target calcium and phosphate levels.
Note: The daily allowance of elemental calcium from phosphate binders should not exceed 1,500 mg, and the total amount of elemental calcium from all sources should not exceed 2,000 mg.

Pregnancy Risk Factor C

It has not yet been tested in pregnant women. It crosses the placental boundary.
Calcium requirements for pregnant and unpregnant women are identical.

Calcium acetate use during breastfeeding:

It can be found in breastmilk and can also be used by lactating mothers.
Both lactating and non-lactating women require calcium.

Calcium acetate Dose in Renal Disease:

Adjustment in the dose is not necessary.

Calcium acetate Dose in Liver Disease:

The manufacturer has not provided any adjustment in the dose in patients with liver disease.

Common Side Effects Of Calcium acetate Include:

Endocrine & metabolic:
- Hypercalcemia
Gastrointestinal:
- Diarrhea (oral solution)

Less Common Side Effects of Calcium acetate Include:

Gastrointestinal:
- Nausea
- Vomiting

Contraindication to Calcium acetate include:

Allergy reactions to any component of the drug or the drug itself
Hypercalcemia
Renal calculi

Warnings and Precautions

Gastrointestinal effects:
- It can cause flatulence, constipation, and bloating.
Hypercalcemia:
- Patients who consume excessive amounts of calcium acetate for prolonged periods of time may experience acute and progressive hypercalcemia, which can lead to seizures and cardiac arrhythmias.
- A chronic elevation in calcium levels can lead to generalized vascular or soft-tissuecalcification, which may eventually lead to nephrolithiasis.
- Hypercalcemia has been linked to an increase in mortality among patients with chronic kidney disease.
- Concomitant medications like thiazide diuretics may increase the risk of hypercalcemia.

Arrhythmias:
- Cardiac arrhythmias are more likely to develop when there is hypercalcemia.
Chronic kidney disease
- Patients suffering from CKD should be counseled to use other phosphate binders such as sevelamer and lanthanum, especially if their serum calcium levels are high or normal.
- non-calcium based phosphate binders are thought to reduce cardiovascular mortality in patients with CKD compared to calcium acetate.

Hypoparathyroidism:
- High dosages of vitamin D may cause hypercalcemia and hypercalciuria in hypoparathyroid individuals.

Calcium acetate: Drug Interaction

Risk Factor C (Monitor therapy)
Calcium Channel Blockers	The therapeutic benefit of calcium channel blockers may be reduced by calcium salts.
Cardiac Glycosides	Cardiac Glycosides' ability to induce arrhythmias may be increased by calcium salts.
DOBUTamine	Calcium salts may lessen DOBUTamine's therapeutic effects.
Multivitamins/Minerals (with ADEK, Folate, Iron)	Calcium salts' serum concentration might rise.
Thiazide and Thiazide-Like Diuretics	Calcium Salts' excretion might be reduced. Metabolic alkalosis can also be brought on by continued concurrent usage.
Vitamin D Analogs	The harmful or poisonous effect of vitamin D analogues may be increased by calcium salts.
Risk Factor D (Consider therapy modification)
Alpha-Lipoic Acid	Alpha-Lipoic Acid may not be absorbed as well when exposed to calcium salts. The absorption of calcium salts may be decreased by alpha-lipoic acid.
Bictegravir	Calcium salts may lower the level of bictegravir in the blood. Treatment: Under fed settings, bictegravir, emtricitabine, and tenofovir alafenamide can be provided with calcium salts; however, under fasting conditions, coadministration with or two hours after a calcium salt is not advised.
Bisphosphonate Derivatives	Products containing polyvalent cations may lower the level of bisphosphonate derivatives in the serum. The following oral drugs should not be used within the following time frames: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Pamidronate and zoledronic acid are exceptions.
CefTRIAXone	Calcium Salts (Intravenous) may intensify CefTRIAXone's negative/toxic effects. Calcium and ceftriaxone bind together to generate an insoluble precipitate. Treatment: The use of ceftriaxone in infants (28 days or younger) who need (or are anticipated to need) IV calcium-containing solutions is contraindicated. Flush lines with a suitable fluid in between administrations for treating older individuals.
Deferiprone	Products containing polyvalent cations may lower the level of deferiprone in the serum. Treatment: Give deferiprone at least four hours apart from oral drugs or dietary supplements containing polyvalent cations.
Dolutegravir	Dolutegravir's serum levels may be lowered by calcium salts. Treatment: Dolutegravir should be administered at least two hours before or six hours after oral calcium. Dolutegravir/rilpivirine should be administered at least 4 hours before or 6 hours after taking oral calcium salts. Oral calcium and dolutegravir can also be consumed with meals.
Eltrombopag	Products containing polyvalent cations may lower the serum concentration of eltrombopag. Treatment: Give eltrombopag at least two hours before or four hours after taking any oral medication containing polyvalent cations.
Estramustine	Calcium salts might make it harder for estramustine to be absorbed.
Multivitamins/Fluoride (with ADE)	Calcium salts' serum concentration might rise. Fluoride and multivitamin serum concentrations may be lowered by calcium salts (with ADE). More specifically, calcium salts might make it harder for people to absorb fluoride. Treatment: Refrain from taking dairy products, vitamins, or dietary supplements containing calcium salts an hour before or an hour after receiving fluoride.
PenicillAMINE	Products containing polyvalent cations may lower the level of penicillAMINE in the serum. Treatment: Give oral medications containing polyvalent cations and penicillamine at least an hour apart.
Phosphate Supplements	Phosphate supplements' absorption may be reduced by calcium salts. Management: This only pertains to the oral administration of calcium and phosphate. It could be possible to reduce the importance of the interaction by giving oral phosphate supplements as far apart from giving an oral calcium salt as possible. Exceptions: Pentahydrate of sodium glycerophosphate.
Quinolones	Quinolones may be less readily absorbed if you take calcium salts. only when both drugs are administered orally. LevoFLOXacin (oral inhalation) and moxifloxacin are exceptions (Systemic).
Strontium Ranelate	Strontium Ranelate serum levels may be reduced by calcium salts. To reduce this interaction, strontium ranelate and oral calcium salts should be administered at least two hours apart.
Tetracyclines	Tetracyclines' serum levels may be reduced by calcium salts. Management: If oral calcium and oral tetracyclines must be administered simultaneously, think about giving each medication several hours apart. Eravacycline is an exception.
Thyroid Products	The therapeutic value of thyroid products may be reduced by calcium salts. Treatment: Give the thyroid medication and the oral calcium supplement at least 4 hours apart.
Trientine	Products containing polyvalent cations may lower the level of trientine in the serum. Management: Steer clear of combining the use of oral medications containing polyvalent cations with trientine. If oral iron supplements are required, separate the administration by 2 hours. Separate administration of other oral polyvalent cations by one hour if necessary.
Risk Factor X (Avoid combination)
BaloxavirMarboxil	Polyvalent Cation Containing Products may decrease the serum concentration of BaloxavirMarboxil.
Calcium Salts	Calcium acetate's harmful or poisonous effects could be exacerbated

Monitoring parameters:

Monitor the following parameters within 3 months of the start of the therapy or following a dose change, and then at least every 6 to 12 months after that.

Serum phosphorus
Serum calcium and signs and symptoms of hypercalcemia
Serum calcium and phosphorus product
Intact PTH levels

KDIGO recommendations:

CKD stage 3a-3b:
- Monitor Serum calcium and phosphate every 6 - 12 months.
CKD stage 4:
- Monitor Serum calcium and phosphate every 3 to 6 months
- Intact PTH every 6 - 12 months
CKD stage 5 and 5D:
- Monitor Serum calcium and phosphate every 1 - 3 months
- Intact PTH every 3 - 6 months

How to take Calcium acetate?

Administer the drug with meals.
It may interfere with iron absorption and should not be used with iron supplements within one hour of its intake.

Mechanism of action of Calcium acetate:

It is combined with dietary potassium to make calcium phosphate, which is insoluble and excreted in the feces.

The drug can be purchased for between 30 and 40%.absorbedVitamin D is required for absorption. It is necessary to take high doses and for a long time. It is absorbed in its ionized form, and its solubility in acidic environments is increased. It is primarilyexcretedIn the feces.